Veterans_Bradley APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
"tea t WWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERA
`_F '' State Form 12662(R11 110-08)'' '
Prescribed by the Department of Local Government Finance /
INSTRUCTIONS: Please check appropriate box(es)pertaining to tax deduction. (More than one box may b ck d-however, a surviving
spouse who receives a deduction under Section IV may not receive a deduction under IA 2014
FILING DATES:
REAL PROPERTY: DURING THE YEAR FOR WHICH THE DEDUCTION IS SOUGHT.
MOBILE HOMES(IC 6-1.1-7)OR MANUFACTURED HOMES NOT ASSESSED AS REAL PROPERTY:DU" 3-4,44 (12)MONTHS
BEFORE MARCH 31 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO OBTAIN THE ,4. c; •tii OUNTY AUDITOR
1 Totally disabled veteran(or veteran at least age 62 with at least 10%disability)or surviving spouse-Not to exceed 512,480
Complete sections I,V and VI. (IC 6-1.1-12-14)
II Partially service-connected disabled veteran OR surviving spouse-Not to exceed 524.960
Complete sections II,V and VI. (IC 6-1.1-12-13)
❑ III World War I Veteran-Not to exceed 518.720
Complete sections III,V and VI. (IC 6-1.1-12-17.4)
❑ IV Surviving spouse of World War 1 Veteran-Not to exceed 518.720
Complete sections IV,V.and VI. (IC 6-1.1-12-16)
'a�ssxE':riA..a e. _=.1- to 1/24,i/-Si- a.,:.- 044`z -APPLICANTS S -^'-4"-ti:Lia-j1 Wi :i 3 -*27.:5: _ '.
Name of ap�- (fi middle,last) �.( ''V
Address(00 t nurp6pr,�y, te,a ZIP (th] l Li 7C0 Lt 3 I Cou,j�` / ^-
Applicant toes aloes not ) own propirrty with another individual(s)besides s4ouse and/or another veteran.
This application is made for the purpose of obtaining S deduction from the assessed valuation of the following described taxable
property for.the year 20 .
Taxi tnct( fowl,t li gt a property in question-: Parcel or Key number _.�.S
Real Property ❑ Mobile Home(IC 6-1.1-7) (96-43 -06-d � ?Wan a n
l L. ;
Taxi
f nxg ;x .�+, SECTION 1-= Tota;DisatiibtyOR a[deastiag162with atlea-st,10%1_dsabdity{- - r" iam _ �.,-t:
' A❑App5pnt was a member of the U.S.Armed Forces for at least 90 days(not necessarily dining wartime).
B.❑Applicant was honorably discharged.
C.❑Applicant is: ❑Totally disabled:or
❑At least age 62 with at least 10%disability
D.❑Applicant's disability is evidenced by: ❑Certificate of el gibifity from the Indiana Department of Veterans Affairs;
❑Pension certificate;
❑Award of compensation from Veterans Administration or Department of Defense;or
❑Veterans Administration Form 20-5455"Tax Abatement Certificate'
E.❑The assessed valuation(at 100%)of the property for which the deduction is claimed(may not exceed$143,160) S
F. ❑Appfxant is the surviving spouse of an individual who would have qualified for the deduction under this section when he or she was alive.
(Age of deceased veteran on date of death )
r„ ct A.. � ,rzs ,a:'.SECTION'll o Parti`ahDisabili LT - „ 7x'-.-,.4'01,aJ-`t_ . .�o'2dl
A. Applicant was a member of the U.S.Armed Forces during any of its wars.
B. Applicant was honorably discharged.
C. Applicant has a service connected disability of at least 10%
D. Applicant's disability is evidenced by: ,Certificate of eligibility from the Indiana Department of Veterans Affairs;
❑Pension certificate;
❑Award of compensation from Veterans Administration or Department of Defense;or
❑Veterans Administration Form 20-5455-Tax Abatement Certificate'
E. ❑Applicant is the surviving spouse of an individual who would have qualified for the deduction under this section when he or she was alive.
(Age of deceased veteran on date of death )
`- r 1 T:f ` t;-.SECTION.III _,-WorldrWar',Veteran 1732,- ^r e^,-'�„" 4 -:43."4-qte
A ❑Appb ant is a veteran of World War I.
B. ❑Appf ant's service is evidenced by: ❑Letter from Veterans Administration or Department of Defense;or
❑Discharge documents
C.❑The assessed valuation(at 100%)of the property for which the deduction is claimed(may not exceed S206,500) S
D.❑The property is the applicant's principal residence.
E. Lime app6 ant owned the property(or was buying it under contract)for at least one year before the date of this application.
1I,vtttir C—A—c--.,;,t`It± :{e ,', {` -tk i.*`K SECTIONStiv,V,AND'VPARE ON REVERSE Qn; ''avr45.-"c-°2 .rus.a -'r`-r `-Fg4' a',-`.'F
s'a' Z r •'. c;it SECTION9V V Survivin• Souse of•a WorldhWaal Veteran
A.❑Applicant is the surviving spouse of an individual who served in the U.S.Armed Forces before November 12,1918.
B.❑ The service of the deceased spouse is evidenced by: ❑Letter from the Veterans Administration or the Department of Defense:or
❑ Honorable discharge documents
C.❑ The deceased spouse received an honorable discharge.
'�i -� �:ys•?:xz +s:.. '"o - 'ga95ECTION V pAdditionaPlnformatron . •.— � - .. v s. ,. � 647ii't_
A. plicant owns the property on which the deduction is claimed or is buying it under contract that provides that the applicant is to pay the property taxes.
which contract,or a memorandum of the contract,is recorded in the County Recorder's office. Record number page
B.❑Applicant has applied or intends to apply for one or more of these deductions on other properly in this county or in another county.
❑ Yes No Amount S
County Taxing district
Second county Taxing district
. h'.';�� .l�� r•;'�,SECTION:VI p<A.•iieetion Verification and Auditor Signature•'-is -4...1,.-2"4" no -r e`" A =-
I certify that this application was filed in my office.
I certify that the information provided in this application is true and Date filed(mon day,year)
correct The intentional inclusion of false information on this form is -OL v-/ y`
a criminal violation under IC 6-1.1-37-3 or 4. Signature of 'nt auditor
Sig/1 raapplign[ar legal sentativ Name or tpRn /a1 1 I or writ in /
l[JV�y/// '1 P�Gn // VETERAN DEDUCTION•WORRKKSSHEET:�,.:- J,
20 20 20
1. Total Disability(512.480)
2. Partial disability(524,960)
3. WWI Veteran(518,720)
4. WWI surviving spouse(518,720)
5. Total deduction available(add lines 1,Z 3 and 4)
6. Amount applied to real estate key number
7. Amount applied to personal property duplicate number
8. Amount applied to mobile home duplicate number
9. Total deduction applied to taxable property(add lines 6, 7 and 8)
10. Deduction available for excise'(subtract line 9 from line 5)
11. Excise credit
May be used as an excise tax credit on either the Motor Vehicle Tax (IC 6-6-5-5)or Aircraft License Excise Tax(IC 6-6-6.5-13)
calculated at$2.00 per$100.00 for cars and for aircraft[see 6-6-6.5-13(e))of unused veteran's deduction.
The information contained on this form is CONFIDENTIAL according to IC 6-1.1-35-9.